急性冠状动脉综合征患者介入术后急性肾损伤与短期预后的关系  

Relationship between acute kidney injury after interventional therapy and short-term prognosis in patients with acute coronary syndrome

作　　者：毛婉 刘文光 唐永祯 马震[1] 庄晓赛[1] 解慧新 MAO Wan;LIU Wen-guang;TANG Yong-zhen;MA Zhen;ZHUANG Xiao-sai;XIE Hui-xin(Department of Cardiovascular Medicine,Fuyang People's Hospital,Fuyang 236000,Anhui,China;Department of Cardiovascular Medicine,Nanfang Hospital Affiliated to Southern Medical University,Guangzhou 510515,Guangzhou,China)

机构地区：[1]阜阳市人民医院心血管内科,阜阳236000 [2]南方医科大学附属南方医院心内科,广州510515

出　　处：《医学研究生学报》2020年第2期159-163,共5页Journal of Medical Postgraduates

基　　金：国家“十三五”精准医学计划重点专项(2016YFC0903100)。

摘　　要：目的经皮冠状动脉介入治疗(PCI)可能造成部分急性冠状动脉综合征(ACS)患者急性肾损伤(AKI),从而导致持续性的肾功能障碍。文中探讨行PCI的ACS患者AKI与短期预后的关系。方法回顾性选择阜阳市人民医院接受PCI治疗的333例ACS患者资料,并根据PCI术后第1~3天血清肌酐水平分为AKI组(n=38)和非AKI组(n=295)。分析ACS患者PCI术后发生AKI的危险因素,并对比2组患者术后不良心血管事件发生率和生存率。采用多因素分析方法确定影响短期生存的危险因素。结果年龄、糖尿病、术前肾功能不全、左心室射血分数(LVEF)、造影剂用量及病变冠状动脉支数是PCI术后发生AKI的独立危险因素(P<0.05)。术后1年内,AKI组和非AKI组患者心血管不良事件总发生率分别为28.9%和5.8%,差异有统计学意义(χ~2=20.582,P=0.000)。全组患者随访时间2.9~17.2个月,中位随访时间8.6个月。AKI组和非AKI组术后6个月累积生存率分别为94.1%和99.6%,术后1年累积生存率分别为84.2%和96.1%,两组总生存率差异有统计学意义(χ~2=9.216,P=0.002)。PCI术后短期生存与AKI(χ~2=20.582,P=0.000)、LVEF(χ~2=9.055,P=0.003)、病变冠状动脉支数(χ~2=5.749,P=0.016)及术前Killip分级(χ~2=4.823,P=0.028)有关,其中AKI与LVEF是PCI术后短期生存的独立预测因素(P<0.05)。结论 ACS患者PCI术后并发AKI提示短期预后较差,可作为病情评估和危险分层的重要因素。Objective Percutaneous coronary intervention(PCI) may cause acute kidney injury(AKI) in some patients with acute coronary syndrome(ACS), leading to persistent renal dysfunction. This study aimed to investigate the relationship between acute kidney injury after PCI and short-term prognosis in patients with ACS. Methods Data of 333 patients with ACS who underwent PCI in our hospital were included. According to whether the serum creatinine level was increased above 25% during 1 st to 3 rd day after PCI than the preoperative, patients was divided into AKI group(n=38) and non-AKI group(n=295). Risk factors for AKI in patients with ACS after PCI were analyzed. Adverse cardiovascular events and survival rates between the two groups were compared. Univariate and multivariate analysis were performed to determine the risk factors on short-term survival after surgery. Results Age, diabetes, preoperative renal insufficiency, left ventricular ejection fraction(LVEF), contrast dose and count of lesion coronary artery were independent risk factors for AKI after PCI(P<0.05). Within 1 year after surgery, the total incidence of cardiovascular adverse events in the AKI group and the non-AKI group were 28.9% and 5.8%, respectively, and the difference was statistically significant(χ~2=20.582, P=0.000). The patients were followed up for 2.9 to 17.2 months with a median follow up of 8.6 months. The 6-month cumulative survival rate of AKI group and non-AKI group were 94.1% and 99.6%, respectively. The 1 year cumulative survival rate was 84.2% and 96.1%, respectively. The difference in overall survival rate between the two groups was statistically significant(χ~2=9.216, P=0.002). Short-term survival after PCI was associated with AKI(χ~2=20.582, P=0.000), LVEF(χ~2=9.055, P=0.003), count of lesion coronary artery(χ~2=5.749, P=0.016) and preoperative Killip grading(χ~2=4.823, P=0.028). AKI and LVEF were independent predictors of short-term survival after PCI(P<0.05). ConclusionAKI in patients with ACS after PCI has a poorer short-term

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入治疗 急性肾损害 造影剂肾病 预后 

分 类 号：R604[医药卫生—外科学]